HIMSS Patient-Centered Payer Roundtable. November 15, PDF Free Download

HIMSS Patient-Centered Payer Roundtable November 15, 2012

Agenda Welcome 2-Minute Drills Topic discussion Housekeeping Call to Order and Roll Call (David Fitzgerald, Shelley Price) Join the Roundtable Speakers Team (Kim Harding) Join the Roundtable Communications Team (Deanne Kasim) Election Healthcare Post Mortem (Kim Slocum) 101 Part 2 Completing the Plumbing: Interoperability, Meaningful Use, the Affordable Care Act, and S&I Framework (Jim St. Clair, Senior Director, Interoperability and Standards, HIMSS) (Shelley Price) Adjournment 2

2 Minute Drill: Call to Join the PCPR Speakers Team Join the Roundtable s Speakers Team and further knowledge sharing and partnership building! The Speakers Team is responsible for topics and content for roundtable. It identifies and invites speakers, with input from leadership team, and maintains the high level of quality of content. What do we want you to do? Use your ear to the ground to identify and pull in emerging trends, new ideas, key issues, critical content areas, and high quality speakers. Generate ideas and potential speakers for upcoming HIMSS events and webinars as needed, HIMSS13 payer events like the networking luncheon. Build a successful, engaging, and beneficial roundtable! Contact Shelley Price, HIMSS / sprice@himss.org Nancy Devlin, HIMSS / ndevlin@himss.org Kim Harding, PCPR Speakers Team Co-Chair / Kimberly.Harding@floridablue.com / 904.905.6048 Lance Stewart PCPR Speakers Team Co-Chair / Lance.Stewart@emids.com / 615.638.2255 4

2 Minute Drill: Call to Join the PCPR Communications Team Do you like staying abreast of the latest health IT news in the payer community? Are you interested in furthering Payer-Provider collaboration, knowledge generation, and solution sharing? Would you like to continue the learnings and discussions from the HIMSS Patient-Centered Payer Roundtable (PCPR) monthly meetings with peers and industry leaders? Join the Roundtable s Communications Team and further the dialogue! A CALL for Payer / Health plan blogs Be a HIMSS Payer guest blogger. A CALL for Articles for the Author brief (300-750 words) news stories, thought pieces, and Roundtable recaps for the HIMSS Payer Insider (bi-monthly in the Healthcare Payer News). Don t let this opportunity pass you by! Get connected, lead the conversation, and be heard! Contact Shelley Price, HIMSS / sprice@himss.org / 703-562-8846 Nancy Devlin, HIMSS / ndevlin@himss.org / 734-477-0857 Deanne Kasim, PCPR Communications Team Chair / dkasim@santesys.net / 301-926-8400 5

2 Minute Drill: Election Healthcare Post Mortem 6

101 Part 2 Completing the Plumbing: Interoperability, Meaningful Use, the Affordable Care Act, and S&I Framework Jim St.Clair Senior Director, Interoperability and Standards, HIMSS

IT Implications from HITECH and the ACA HITECH Health Information Exchange: data sharing, standardization, data analysis Meaningful Use : Stage 1/Stage 2/ Stage 3? Implementation of Certified EHR Technology Revisions to HIPAA Security and Privacy EFT/ERA and medical banking

IT Implications from HITECH and the ACA ACA (cont d) Integrated Accountable Care ACOs and PCMHs Health Insurance Marketplaces (HIMs) Continued growth of electronic transactions CAQH CORE ACH/EFT/ERA

The Age of Meaningful Use Stage 1 (2011) Focus on effective capturing and sharing of data, with providers demonstrating meaningful use. Stage 2 (2014) Demonstrate health system improvement, with widespread adoption of data exchange and advanced care processes with decision support. Stage 3 (2015+/-) Transform healthcare and population health through HIT, with improvements in care, efficiency, and population health, highlighting breakthrough examples of delivery and payment reform. 11

For Providers, A Busy Few Years 2011 Meaningful Use Phase I 2012 2013 2014 2015 5010 Implementation (Jan 1) Eligibility, Claim Status Meaningful Use Phase II ICD10 Implementation (Oct 1) EFT, ERA Meaningful Use Phase II 2016 Claims, Enrollment, Premium, Referral, Authorizations

MU Objectives aligned by policy priorities Improving quality, safety, efficiency, and reducing health disparities Improving quality, safety, efficiency, and reducing health disparities Engage patients and families in their health care Ensure adequate privacy and security protections for personal health informaiton Improve care coordination Improve population and public health

MU Stage 2 objective requirements Eligible Providers (EPs): 16 Core Objectives 2 Menu 24 Objectives CQM (of 4) Eligible Hospitals/Critical Access Hospitals (EH/CAHs): 17 Core Objectives 3 of 5 Menu Objectives (of 5) 12 CQM (Or PQRS)

The Triple Aim Improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Preconditions for this include the enrollment of an identified population, a commitment to universality for its members, and the existence of an organization (an integrator ) that accepts responsibility for all three aims for that population. Source: http://content.healthaffairs.org/content/27/3/759.full.html

The Triple Aim (cont d) The integrator s role includes at least five components: Partnership with individuals and families, Redesign of primary care, Population health management, Financial management, and Macro system integration. Source: http://content.healthaffairs.org/content/27/3/759.full.html

Healthcare in 2014 The role of the physician will change dramatically. Patients will (must!) be engaged in their care and owning their information. ACOs will create winners and losers among providers. Transparency will empower consumers and motivate providers. Health system redesign not just tinkering with payment models. An ounce of prevention is worth a pound of cure and costs a lot less. Expect a significant change in transitions of site care and delivery mechanisms remote and virtual care will become the norm. Primary care will (should) be a major focus in the ACO environment. Source: Accountable Care Organizations: 10 Things You Need to Know About Accountable Care iht2

Disruptive innovation trends Continued growth of retail care delivery Explosive growth of mobile devices and (less explosive) growth of telehealth Personal Health Records (PHRs)/ Health/Wealth portals Big Data

What s Needed Next: Electronic Business Transformation Electronic business transformation may be described as the art of matching the potential to automate workflows and business analytics with new, real time access to electronic health data, as a result of recent federal requirements around health data transactions and operating rules and their ongoing adoption in the marketplace. Creation and adoption of data standards for clinical and non-clinical information exchange 19

Questions? Jim St. Clair Senior Director, Interoperability and Standards, HIMSS (312) 915-9590 jstclair@himss.org 25

Housekeeping Resources at mhimss.org: Results from the inaugural Mobile Survey by HIMSS Analytics Participate in the second annual Mobile Survey sponsored by Qualcomm life. White Paper: Selecting a Mobile App: Evaluating the Usability of Medical Applications Leading Industry Newsletter The mhimss App; available on both Android and ios. (To Become a Member Click on the Banner Below) Coming Soon! The mhimss Roadmap: A Guide to Mobile Integration

Visit the Summit Website Register Now Contact Us NEWS FROM THE mhealth SUMMIT 3 WEEKS UNTIL THE 2012 MHEALTH SUMMIT AVOID LINES AND ONSITE PRICES! 2012 SUMMIT OFFERS STRONG FOCUS ON MOBILE STARTUP SPACE! Join StartUp Health Roundtable: The State of Innovation in Mobile Health on Monday 12/3 at 4:15 PM Sign up for Health 2.0 State of Change: Pioneers, Progress, and a 2013 Forecast on Sunday 12/2 at 1:00 PM

Housekeeping Online Election for Board, Nominating Committee The annual election of the Board of Directors and Nominating Committee began Oct. 15 and will run through Nov. 15. Please take this opportunity to vote at https://www.directvote.net/himss/ Board of Directors Candidates Beverly Bell, RN, BS, MHA, CPHIMS, FHIMSS Carl Dvorak, FHIMSS Elizabeth (Beth) Halley, RN, MBA, FHIMSS Alfred Hamilton, PhD, FHIMSS Lesley D. King, MA, FHIMSS Cynthia A. Peterson John R. (Rick) Schooler, MBA, FCHIME, FACHE, FHIMSS Ferdinand T. Velasco, MD, FHIMSS Michael H. Zaroukian, MD, PhD, FACP, FHIMSS Nominating Committee Candidates Melinda Costin, CHCIO, FHIMSS Linda Harrington, PhD, RN-BC, CNS, CPHQ, CENP, CPHIMS, FHIMSS Laura L. Kolkman, RN, MS, FHIMSS Shawna Schueller, FHIMSS Dana Sellers Tim Moore, RN, CIO Barbara S. Riddell, MHA, MSN, PMP, CHCIO

Resources: Wrap-up HIMSS Calendar of Events: http://www.himss.org/asp/confcalendarhome.asp Webinars and Audio Conferences http://www.himss.org/asp/confcalendarhome.asp?cetid=200 30

Web page Wrap-up Payer Topics and Tools page!. http://www.himss.org/asp/topics_payers_healthplans.asp http://www.healthcarepayernews.com/himss-payer-insider Next meeting 3 rd Thursday of the month from 4-5pm EST Thursday, December 20, 2012 31

FY13 Leadership and Contact Information Chairperson: David Fitzgerald Enterprise Systems Architect Manager Aetna FitzgeraldD2@Aetna.com Vice Chairperson: Gary Austin Principal & Co-Founder, TranzformHealth GAustin@TranzformHealth.com HIMSS Staff Liaison: Shelley Price Director, Payer and Life Sciences HIMSS sprice@himss.org Nancy Devlin Sr Assoc., Payer and Life Sciences HIMSS ndevlin@himss.org 32

HIMSS Patient-Centered Payer Roundtable. November 15, 2012